大肠侧向发育型肿瘤的临床特征及内镜下手术治疗效果观察  

Laterally spreading tumors: Clinical features and curative effects of endoscopic surgery

作　　者：张艳 张伟[2] 张莹[3] Yan Zhang;Wei Zhang;Ying Zhang(Department of Gastroenterology,Affiliated Xiang’an Hospital of Xiamen University,Xiamen 361005,Fujian Province,China;Department of General Surgery,Anyang Tumor Hospital,Anyang 455000,Henan Province,China;Department of Gastroenterology,Anyang People’s Hospital,Anyang 455002,Henan Province,China)

机构地区：[1]厦门大学附属翔安医院消化内科,福建省厦门市361005 [2]安阳市肿瘤医院普外一科,河南省安阳市455000 [3]安阳市人民医院消化内科,河南省安阳市455002

出　　处：《世界华人消化杂志》2018年第36期2102-2108,共7页World Chinese Journal of Digestology

摘　　要：目的探讨大肠侧向发育型肿瘤(laterally spreading tumors,LST)的临床特征及内镜下手术治疗效果.方法选择2015-01/2016-01厦门大学附属翔安医院消化内科收治的120例LST患者为研究对象,均接受内镜下手术治疗.记录患者年龄、性别、病变大小、LST分型、病变部位、病理类型、腺管开口,并分析腺管开口、腺管分型与病理分型关系以及治疗情况.结果120例患者中男女比例为1.61:1,年龄以60-69岁、50-59岁最为多见;病灶直径主要为20-29cm;病灶主要位于直肠,其次为乙状结肠;病理分型以绒毛状腺瘤最为多见,其次为管状绒毛状腺癌;病灶分型以颗粒均一型最为常见,其次为结节混合型;腺管开口主要为ⅢL型;结节混合型和颗粒均一型均以Ⅳ型开口为主,假凹陷型以ⅤA型开口为主,扁平隆起型以ⅢL型开口为主,差异具有统计学意义(P <0.05);ⅤA型腺管开口均为黏膜内癌,Ⅳ型多为绒毛状腺瘤,ⅢL型多为管状腺瘤,差异具有统计学意义(P<0.05);行内镜黏膜下层剥离术(endoscopic submucosal dissection,ESD)治疗9例(7.50%),内镜黏膜切除术(endoscopic mucosalresection,EMR)治疗61例(50.83%),内镜分次黏膜切除术(endoscopic piecemeal mucosal resection,EPMR)治疗50例(41.67%);EMR和EPMR组LST病灶分布主要为结肠和直肠, ESD组均分布为直肠,差异具有统计学意义(P <0.05); EMR组LST直径主要为10-19 cm、20-29 cm, ESD组和EPMRLST直径主要为20-29cm以上,差异具有统计学意义(P <0.05);EPMR术后复发率高于EMR组、ESD组,差异具有统计学意义(P<0.05);三组出血率比较,差异无统计学意义(P>0.05).结论LST好发于男性,中老年人群易患病;病变大小多为20-29cm;直肠为其好发部位;病灶分型主要为颗粒均一型、结节混合型,腺管开口主要为ⅢL型,病理类型多为绒毛状腺瘤,不同病理分型、病灶分型腺管开口存在明显差异; EMR和EPMR术是治疗LST的常见术式, ESD常用于治疗直肠病变; EPAIM To investigate the clinical features of laterally spreading tumors(LST)and the curative effects of endoscopic surgery.METHODS One hundred and twenty LST patients treated at the department of gastroenterology of Affiliated Xiang’an Hospital of Xiamen University from January 2015 to January 2016 were included,and all of then underwent endoscopic surgery.Age,gender,size of lesion,LST classification,location of lesion,pathological pattern,and pit pattern were recorded.The relations of glandular tube opening and pit pattern with pathological classification as well as curative situations were analyzed.RESULTS The ratio of male to female in 120 patients was 1.61:1,and the most common age groups were 60-69 and 50-59.The lesion diameter was mainly 20-29 cm.The rectum was the most frequently involved location,followed by the sigmoid colon.Villous adenoma was the most common pathological classification,followed by tubular villous adenocarcinoma.Homogeneous granular type was the most common type of lesion,followed by nodular mixed type.The pit pattern was mainly ⅢL type.The nodular mixed type and homogeneous granular type mainly had type Ⅳ openings,the pseudo-depressed type mainly had ⅤA type openings,and the flat elevated type mainly had ⅢL type openings;the difference among them was statistically significant(P<0.05).The ⅤA type glandular tube opening was intramucosal carcinoma,Ⅳ type was mainly villous adenoma,and ⅢL type was mainly tubular adenoma;the difference among them was statistically significant(P<0.05).There were 9(7.50%)cases who underwent endoscopic submucosal dissection(ESD),61(50.83%)who underwent endoscopic mucosal resection(EMR),and 50(41.67%)who underwent endoscopic piecemeal mucosal resection(EPMR).The lesion locations of LST in the EMR and EPMR groups were mainly the colon and rectum,and that in the ESD group was mainly the rectum;the difference was statistically significant(P<0.05).The LST diameter in the EMR group was mainly 10-19 cm and 20-29 cm,while that in the ESD group and EPMR

关 键 词：大肠侧向发育型肿瘤 临床特征 内镜 手术 

分 类 号：R735.34[医药卫生—肿瘤]